Duodeno-ileal diversion with self-forming magnets in a sutureless neodymium anastomosis procedure (SNAP) for weight recidivism after sleeve gastrectomy: feasibility and 9-month results

Surg Endosc. 2024 Sep;38(9):5199-5206. doi: 10.1007/s00464-024-11090-5. Epub 2024 Jul 23.

Abstract

Background: The sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. However, insufficient weight loss or weight recidivism is frequent, which may require effective and safe revisional procedures.

Objective: To determine the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using a Sutureless Neodymium Anastomosis Procedure (SNAP) for patients with weight recidivism or inadequate weight loss following SG.

Methods: This is a prospective, single-arm, open-label pilot study that enrolled patients with obesity to assist in weight reduction following an SG performed > 12 months prior. For the SNAP, self-assembling magnets were deployed into the ileum (laparoscopically) and duodenum (per-oral endoscopy). Magnets were coupled under laparoscopic and fluoroscopic guidance to create a compression anastomosis. The primary endpoints were technical feasibility, weight loss, and rate of serious adverse events (SAEs).

Results: Successful duodeno-ileal diversions were created with SNAP in 27 participants (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with no device-related serious adverse events. Upper endoscopy at 3 months confirmed patent, healthy anastomoses in all patients. At 9 months, patients (n = 24) experienced 11.9 ± 6.2%, 14.5 ± 10.8%, and 17.0 ± 13.9% TBWL at 3, 6, and 9 months, respectively. There were no device-related SAEs.

Conclusion: The SNAP is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at 3 months. Patients experienced a progressive, clinically meaningful weight loss. Further studies are needed to confirm our findings.

Keywords: Duodeno-ileal anastomosis; Magnets; Obesity; Revision; Sleeve gastrectomy.

MeSH terms

  • Adult
  • Anastomosis, Surgical* / methods
  • Bariatric Surgery / methods
  • Duodenum* / surgery
  • Feasibility Studies*
  • Female
  • Gastrectomy* / methods
  • Humans
  • Ileum / surgery
  • Laparoscopy / methods
  • Male
  • Middle Aged
  • Neodymium
  • Obesity, Morbid / surgery
  • Pilot Projects
  • Prospective Studies
  • Treatment Outcome
  • Weight Loss*

Substances

  • Neodymium